Lifestyle modifications focused on healthy eating and regular exercise are the primary recommendations for patients with nonalcoholic steatohepatitis (NASH). However, for multiple societal, psychological, physical, genetic, and epigenetic reasons, the ability of people to adopt and sustain such changes is challenging and typically not successful. To end the epidemic of NASH and prevent its complications, including cirrhosis and hepatocellular carcinoma, pharmacological interventions are now being evaluated in clinical trials. Treatments include drugs targeting energy intake, energy disposal, lipotoxic liver injury, and the resulting inflammation and fibrogenesis that lead to cirrhosis. It is likely that patients develop the phenotype of NASH by multiple mechanisms, and thus the optimal treatments of NASH will likely evolve to personalized therapy once we understand the mechanistic underpinnings of NASH in each patient. Reviewed here is the treatment landscape in this rapidly evolving field with an emphasis on drugs in Phase 2 and Phase 3 trials.

中文翻译：

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2020年NAFLD的治疗景观。

针对非酒精性脂肪性肝炎（NASH）患者的主要建议是，改变生活方式，着重于健康饮食和定期运动。但是，由于多种社会，心理，身体，遗传和表观遗传原因，人们采用和维持这种变化的能力具有挑战性，通常并不成功。为了结束NASH的流行并防止其并发症（包括肝硬化和肝细胞癌），目前正在临床试验中评估药理干预措施。治疗包括针对能量摄入，能量处置，脂毒性肝损伤以及由此导致的导致肝硬化的炎症和纤维生成的药物。患者可能通过多种机制发展出NASH表型，因此，一旦我们了解了每位患者NASH的机制基础，NASH的最佳治疗方法就有可能演变为个性化治疗。本文回顾了这个快速发展的领域中的治疗前景，重点是2期和3期试验中的药物。